引导组织再生即刻种植术的临床研究

目的 评价引导组织再生（ＧＴＲ）即刻种植术后的临床效果,探讨影响其效果的临床因素。方法 将２５颗种植立即植入２５例患者的新鲜拔牙窝,聚四氟乙烯（ＰＴＦＥ）膜覆盖于牙槽嵴顶封闭拔牙窝,松驰唇颊侧粘骨膜瓣,严密缝合。术后当天、１０天、１、２、３、４、５和６个月拍Ｘ光片检查种植体周骨缺隙骨再情况。术后６个月拆除ＰＴＦＥ膜。完成修复后随访观察一年。结果 无种植体松动或脱落;术后２个月新生骨充满种植体周缺隙     

骨形成蛋白与胶原膜联合应用促进即刻种植体周骨组织再生的实验研究

目的 比较单独应用胶原膜和胶原膜与人骨形成蛋白（ｈＢＭＰ）联合应用引民即刻种植体周骨缺隙骨再生的效果。方法 将复合有ｈＢＭＰ和ｈＢＭＰ的相同种植体分别植入１２只成年杂种狗下颌拨牙窝,覆盖胶原膜。于术后２、４、８、１２周每次处死狗３只,取格,扫描电子显微镜观察。结果 在种植体周骨缺隙部,有ｈＢＭＰ组２周时即有大量新骨形成,８周时骨缺隙完全由成熟的骨质充填,而无ｈＢＭＰ组,１２周时种植体周骨缺隙由仍未     

引导组织再生即刻种植术的临床研究

目的 :评价引导组织再生 (GTR)即刻种植术的临床效果 ,探讨影响其效果的临床因素。方法 :将 2 5颗种植立即植入 2 5位患者的新鲜拔牙窝 ,聚四氟乙烯 (PTFE)膜覆盖于牙槽嵴顶封闭拔牙窝 ,松驰唇颊侧粘骨膜瓣 ,严密缝合。术后当天、10天、1、2、3、4、5和 6个月拍X光片检查种植体周骨缺隙骨再生情况。术后 6个月拆除PTFE膜。完成修复后随访观察一年。结果 :无种植体松动或脱落 ;术后 2个月新生骨充满种植体周缺隙 ;术后 6个月新骨完全成熟 ,并与种植体紧密结合 ;膜早期暴露可导致种植体周牙槽嵴顶骨明显吸收。结论 :GTR即刻种植术能取得与延期种植相同的临床效果 ;膜的屏障作用最少应保持 2个月 ,术后 6个月是拆膜的最佳时间 ;膜早期暴露及其处理对GTR的效果有明显的影响     

骨引导再生在牙种植外科的应用

骨引导再生在牙种植外科的应用ＰＡＵＬＨＦＵＱＡＺＺＯＴＴＩ（ＵＫ）广东省口腔医院（５１０２６０）张文忠译黄建生校组织引导再生（ＧＣＴ）已成功地以多种方式应用于种植外科，拔牙后即刻种植术中的多聚四氟乙烯膜（ｅＰＴＦＥ）的应用及在暴露种植体上的骨再生已取...     

骨挤压联合骨引导再生术在上颌前牙种植中的应用

目的 评价上颌前牙区牙槽骨吸收的患者应用骨挤压联合骨引导再生术行种植体植入的临床效果。方法 16例上前牙单牙缺失伴牙槽骨萎缩的患者，应用骨挤压联合骨引导再生术植入16颗种植体，术后6个月暴露种植体，最终完成烤瓷冠修复。结果 术后无明显并发症发生，修复完成后观察7～26个月，种植体行使功能良好，无种植体丧失。结论 对上颌前牙区牙槽骨吸收的患者，应用骨挤压联合骨引导再生术行种植体植入，可改善牙槽骨质，保存骨量，临床效果良好。     

聚羟基丁酸酯膜引导即刻植入种植体周围骨组织再生的研究

目的：评价聚羟基丁酸酯（ＰＨＢ）膜引导种植体周围骨组织再生的效果。方法：在狗下颌骨即刻植入种植体的颊侧形成骨缺损,覆盖ＰＨＢ膜,与钛膜及空白对照比较,术后１、２、３个月分别取标本,采用大体观察、Ｘ线摄片、组织学、四环素荧光标记方法观察骨组织再生情况。结果：ＰＨＢ膜组种植体周围骨缺损区较空白组有更多的新生骨充填,加速了骨再生过程,与钛膜组类似。结论：ＰＨＢ有良好的生物相容性,可以用作骨组织引导再生膜     

引导骨再生膜技术在上颌前牙缺失伴重度骨缺损中的应用

目的：评价引导骨再生技术（GBR）在上颌前牙缺失伴重度骨缺损的种植修复效果。方法：选择30例上颌前牙缺失伴重度骨缺损患者,植入Xive种植体62枚,在骨缺损区植入Bio-Oss骨粉,Bio-Gide膜覆盖,重建牙槽骨的高度和宽度;8-10个月后二期手术,术后6周种植修复。结果：62枚种植的Xive种植体,观察最长48个月,最短12个月,种植体存留率100%。结论：骨再生引导膜技术（GBR）在上颌前牙缺失伴重度骨缺损中的临床应用效果稳定,有效。     

上置法植骨技术与种植修复

目的：为了恢复缺牙后重度吸收牙槽嵴的三维骨量,继而行种植体植入,探讨上置法植骨技术及结果。方法：３３例重度吸收牙槽嵴患者接受了上置法槽骨术,平均３个月植入了４５颗种植体。术后６个月行种植体暴露术,暴露后６周行烤瓷冠修复。结果：所有病例修复后平均追踪１１个月,未见种植体脱落。结论：上置法植骨技术简单,效果可靠。     

聚四氟乙烯膜及几丁质膜在即刻种植中应用的实验研究

目的通过动物实验，比较研究国产聚四氟乙烯膜、几丁质膜和钛加强的聚四氟乙烯膜在牙即刻种植中引导种植体周围骨缺损区新骨生成的作用。方法12条杂种狗，拔除左侧下颌四个前磨牙，即刻植入4枚长10mm种植体，3枚种植体分别覆盖几丁质膜、聚四氟乙烯膜、钛加强的聚四氟乙烯膜，另一枚种植体不盖膜作为对照。术后于2、4、8、12周取材，通过X线、组织学定性及定量观察骨缺损的修复情况。结果盖膜的三组从第2周开始就有明显的骨再生，到第12周时骨缺损区已完全为新骨充填；对照组在任何时间点，新骨的量明显少于盖膜的三组；盖膜的三组之间新骨量没有明显的差异。结论聚四氟乙烯膜、几丁质膜和钛加强的聚四氟乙烯膜均能引导种植体周围骨缺损区的骨再生。     

上颌菲薄牙槽骨劈开同期人工牙种植的初步观察

目的：评价上颌菲薄牙槽骨在行骨劈开同时植入种植体及人工骨后的临床效果。方法：对9例上颌牙缺失、剩余牙槽骨宽度为3-4mm、高度大于12mm的病例，行骨劈开，植入29颗种植体，同时在缺隙处植入Bio—Oss骨粉。结果：术后6-8个月X线片检查种植体骨结合良好。行二期手术，重新暴露术区，发现牙槽嵴植骨区已矿化，27颗种植体牙槽嵴顶骨厚度5-6mm．种植体已形成骨结合。有2颗种植体唇／颊侧部分骨质菲薄如牛皮纸，需采用骨组织引导再生技术。所有病例修复后美学效果好。追踪12个月以上，无种植体失败。结论：牙槽骨劈开同期植入种植体。解决了上颌菲薄牙槽骨患者的种植修复难题，操作简单，效果良好。在严格控制适应证的前提下，可在临床推广应用。     

Transmucosal healing around peri‐implant defects: crestal and subcrestal implant placement in dogs

Objective: This study was designed to evaluate the transmucosal healing response of implants placed with the junction of the smooth surfaces, either crestal or subcrestal, into simulated extraction defects after healing periods of 1 and 3 months. Materials and methods: A total of 23 Straumann SP ?3.3 mm NN, SLA^® 10 mm implants were placed in the mandibular premolar regions of three greyhound dogs 3 months after the teeth were removed. Five control implants were placed at the crestal bone level, and test implants with surgically created peri‐implant defects of 1.25 mm wide × 5 mm depth were placed either at the crestal (nine implants) or at the 2 mm subcrestal (nine implants) bone level. Implants on the right side were placed 1 month before the dogs were sacrificed, and implants on the left side were placed 3 months before sacrifice. All dogs had daily plaque control following surgery and were sacrificed 3 months after implant placement for histological and histometric analyses. Results: Mesial–distal ground sections of the control and test implant specimens showed a greater %BIC in the coronal defect region after 3 months of healing. This healing response was incomplete for the test implants compared with the control implants after a 1‐month healing period. The histometric measurements for test implants placed at the crestal bone level or 2 mm subcrestal with surgically created peri‐implant defects were more coronal or closer to the implant margin compared with the control implants. Additionally, the degree of osseointegration between the newly formed bone and the implant surface was similar between the test implants. Conclusion: Peri‐implant defects of 1.25 mm width healed with spontaneous bone regeneration around implants placed transmucosally at crestal or 2 mm subcrestal with a high degree of osseointegration after a 3‐month healing period. To cite this article:
Tran BLT, Chen ST, Caiafa A, Davies HMS, Darby IB. Transmucosal healing around peri‐implant defects: crestal and subcrestal implant placement in dogs.
Clin. Oral Impl. Res. 21 , 2010; 794–803.
doi: 10.1111/j.1600‐0501.2010.01911.x     

Bone regeneration at implants with turned or rough surfaces in self-contained defects. An experimental study in the dog

BACKGROUND: Marginal hard tissue defects present at implants with a rough surface can heal with a high degree of bone fill and osseointegration. The healing of similar defects adjacent to implants with a smooth surface appears to be less predictable. OBJECTIVE: The aim was to compare bone healing at implants with turned or rough surface topographies placed in self-contained defects using either a submerged or non-submerged installation technique. MATERIAL AND METHODS: Six dogs were used. Three months after tooth extraction four experimental sites were prepared for implant installation in both sides of the mandible. The marginal 5 mm of the canal prepared for the implant was widened. Thus, following implant placement a circumferential gap occurred between the bone tissue and the implant surface that was between 1 and 1.25 mm wide. In each side of the mandible two implants with a turned surface and two implants with a rough surface were installed. The implants in the right side were fully submerged, while a non-submerged technique was applied in the left side. The animals were sacrificed 4 months later, block biopsies of each implant site were dissected and ground as well as paraffin sections were prepared. RESULTS: The marginal defects around rough surface implants exhibited after 4 months of healing substantial bone fill and a high degree of osseointegration following either the submerged or the non-submerged installation technique. Healing at turned implants was characterized by incomplete bone fill and the presence of a connective tissue zone between the implant and the newly formed bone. The distance between the implant margin (M) and the most coronal level of bone-to-implant contact (B) at implants with a rough surface was 0.84+/-0.37 mm at submerged and 0.90+/-0.39 mm at non-submerged sites. The distance M-B at implants with a turned surface was 3.39+/-0.52 mm at submerged and 3.23+/-0.68 mm at non-submerged sites. The differences between the rough and turned implants regarding the length of distance M-B were statistically significant (paired t-test). CONCLUSION: Osseointegration at implants placed in sites with marginal defects is influenced by the surface characteristics of the implant.     

Soft tissue healing around implants placed immediately after tooth extraction without incision: a clinical report

PURPOSE: The purposes of the present study were to evaluate implants placed immediately after tooth extraction without incision or primary flap closure and to observe the peri-implant soft tissue healing. MATERIALS AND METHODS: Fifteen patients (9 men and 6 women) aged 31 to 54 years were included in this study. Each patient had a tooth that required extraction, and each had at least 4 mm of bone beyond the root apex. Teeth with multiple roots were excluded from this study. After tooth extraction, the implants were immediately placed without incision or flap elevation. Implant sites showing bone fenestrations, bone dehiscences, or peri-implant bone defects exceeding 2 mm were excluded from this study. In these cases, a standard guided bone regeneration procedure with a surgical flap elevation was used. The second-stage surgical procedure was performed 6 months after the first procedure. The following clinical parameters were evaluated at the time of implant placement and at second-stage surgery: levels of mesial and distal papillae, width of keratinized mucosa, position of mucogingival junction relating to the surrounding tissues, and peri-implant radiolucency and marginal bone loss, which were evaluated radiographically. RESULTS: The postsurgical healing period was uneventful for all patients. Soft tissue closure over the implant sites was achieved in 1 to 3 weeks after surgery at all sites. At second-stage surgery, no peri-implant bone defects were observed or detected by probing around all the experimental implants. The soft tissue anatomy was considered clinically acceptable in all patients. DISCUSSION AND CONCLUSION: Successful osseointegration and complete bone healing were observed for all patients. The soft tissue healing and morphology were satisfactory; additional mucogingival surgery was not required before definitive prosthetic rehabilitation.     

富含血小板血浆诱导口腔种植体周围骨再生的实验研究

目的:通过犬下颌骨种植周围缺损模型,探讨与评估富含血小板血浆与磷酸三钙联合应用后,对种植体骨结合的效应。方法:采用自身对照,在6只成年杂种犬双侧下颌骨下缘各植入2颗纯钛种植体(共24颗)并在种植体周围造成缺损。右下颌2颗为对照组,在缺损处填入磷酸三钙和生理盐水的混合物,左下颌2颗为实验组,在缺损处填入磷酸三钙和富血小板血浆的混合物;术后4、8、12周分别处死2只犬,先后行大体观察、电镜观测和组织学观察。结果:大体观察实验组比对照组缺损处愈合更平整且种植体更稳定;4、8、12周电镜观测时均示实验组和对照组有显著性差异,实验组种植体骨结合率高;组织学观察在实验组可见大量成骨细胞、骨细胞及新生骨小梁,新生骨组织较成熟,而对照组成骨细胞少、骨小梁细而少、纤维组织多见。结论:富含血小板血浆可能具有促进新骨形成及种植体骨结合的效应。     

Bucco-lingual bone remodeling around implants placed into immediate extraction sockets: a case series

BACKGROUND: Implants placed immediately after tooth extraction have shown high percentages of clinical success. Few studies in the scientific literature have observed the horizontal bone remodeling in the buccal-lingual direction after immediate placement of implants. The aim of this study was to analyze bone healing and coronal bone remodeling around 15 implants placed immediately after tooth removal without the use of guided bone regeneration (GBR) techniques. METHODS: Ten patients received a total of 15 implants placed immediately after removal of 15 single-rooted teeth. All implants were placed within the alveolar confines, limiting, in most cases, small peri-implant bone defects. After implant placement, the distance from the buccal to lingual bone plate was measured. No membranes or filling materials were used. Primary flap closure was performed in all cases. RESULTS: At second-stage surgery, all peri-implant defects were completely filled and the distance from buccal to lingual bone was measured again. The pattern of bone healing around the neck of immediate implants showed an absence of peri-implant defects and a narrowing of bone crest width in a buccal-lingual direction. The mean distance between buccal bone and lingual bone at the time of implant placement was 10.5 mm (+/- 1.52) and, at second-stage surgery, 6.8 mm (+/- 1.33). CONCLUSIONS: The coronal bone remodeling around immediate implants showed a healing pattern with new bone apposition around the neck of the implants and, at the same time, bone resorption with horizontal width reduction of the bone ridge. The small peri-implant bone defects were completely healed without the use of GBR procedures. An absence of complications during the healing period was also observed, probably due to the absence of barrier membranes and grafting materials.     

Vertical crestal bone changes around implants placed into fresh extraction sockets

BACKGROUND: The aim of this study was to analyze bone healing and vertical bone remodeling for implants placed immediately after tooth removal without guided bone regeneration techniques. METHODS: Twenty patients received 20 implants immediately after the removal of 20 teeth. All implants were placed within the undamaged alveoli confines, and the cervical portion of each implant was positioned at coronal bone level. The distance from implant shoulder and bone crest was measured for each implant at four sites (mesial, buccal, distal, and palatal/lingual). No membranes or filling materials were used. Primary flap closure was performed in all clinical cases. RESULTS: All peri-implant bone defects had healed completely 6 months after implant placement. The pattern of bone healing around the neck of the implants showed an absence of peri-implant defects. The vertical distance between the implant shoulder and bone crest ranged from 0 to 2 mm. CONCLUSIONS: The bone remodeling of implants placed in fresh extraction sockets showed a healing pattern with new bone apposition around the implant's neck and horizontal and vertical bone reabsorption. The vertical bone reabsorption, which has been observed at buccal sites, was not associated with any negative esthetic implications.     

rhBMP-2在种植体周围骨缺损修复中应用的组织学观察

目的:研究rhBMP-2及不同载体在种植体周围骨缺损修复中的应用。方法:在beagle犬下颌骨植入种植体,颊侧形成裂开性骨缺损,置入复合了不同浓度rhBMP-2的珊瑚羟基磷灰石人造骨(CHA)或可吸收胶原海绵(ACS)。种植体植入后2、4、8、12周,获取含种植体骨标本,进行组织学观察。结果:2周时,rhBMP-2组可见极少量的新生骨组织。4周时,rhBMP-2/ACS组新骨组织由牙槽骨顶端向缺损区中心方向生长;rhBMP-2/CHA组人造骨颗粒内部和周围出现呈岛状生长的新生骨组织。8周时,rhBMP-2/ACS组的新骨形成大片状结构;rhBMP-2/CHA组人造骨颗粒周围较多骨岛形成。12周时,rhBMP-2组的缺损区内骨量和骨高度进一步增加,与种植体形成骨性结合。浓度为0.05 mg/ml和0.2 mg/ml,载体为CHA或ACS促进骨再生作用差异无统计学意义。结论:以CHA或ACS为载体rhBMP-2能促进种植体周围骨缺损区内的骨组织再生并与种植体表面较好地结合。     

Clinical study of guided bone regeneration and/or bone grafts in the treatment of ligature-induced peri-implantitis defects in dogs.

This study evaluated, by clinical analysis, the hard tissue response following treatment of ligature-induced peri-implantitis defects in 5 dogs. The mandibular premolars were removed from both sides of the jaw. After 3 months of healing, two titanium implants were placed on each side of the mandible. Following abutment connection, 3 months later, experimental peri-implantitis was induced by the placement of cotton ligatures in a submarginal position. Ligatures and abutments were removed after one month and the bony defects were randomly assigned to one of the following treatments: debridement (DE), debridement plus guided bone regeneration (GBR), debridement plus mineralized bone graft (BG) and debridement plus guided bone regeneration associated with mineralized bone graft (GBR + BG). The peri-implant bone defects were clinically measured before and 5 months post-treatment. Results showed a higher percentage of vertical bone fill for GBR + BG (27.77 +/- 14.07) followed by GBR (21.78 +/- 16.19), BG (21.26 +/- 6.87), DE (14.03 +/- 5.6). However, there were no statistically significant differences between any of the treatments proposed (one way repeated measures analysis of variance, P = 0.265).     

Tissue integration of non‐submerged implants. l‐year results of a prospective study with 100 ITI hollow‐cylinder and hollow‐screw implants.

It has been postulated that the wound healing in a closed submerged location is one of the prerequisites for osseointegration of dental implants. The purpose of the present study was to evaluate the tissue integration of intentionally non-submerged titanium implants inserted by a one-stage surgical procedure. 100 ITI implants were consecutively placed in 70 partially edentulous patients. After a healing period free of masticatory loading for at least 3 months, the implants were examined. The clinical status showed for all implants neither detectable mobility nor signs of a peri-implant infection. Therefore, prosthetic abutments were inserted, and the patients were restored with fixed partial dentures. All patients were regularly recalled at 3-month intervals, and no patient dropped out of the study. Thus, all 100 implants were re-evaluated 12 months following implantation. Plaque- and sulcus bleeding indices, probing depth, clinical attachment level, width of keratinized mucosa, and periotest scores were assessed. In addition, standardized radiographs were analyzed for the presence of peri-implant radiolucencies and for the location of alveolar bone levels around the implants. Based on predefined criteria, the implants were classified as successful or failing. 98 implants were considered successful, and 1 implant failing. The remaining implant exhibited a peri-implant infection requiring local and systemic antimicrobial treatment. The results of this short-term study indicate that intentionally non-submerged ITI implants yield a high predictability for successful tissue integration.